Manchester VA whistleblower prioritizes patient care, facility conditions

  • Dr. William Kois is seen at the Manchester Veterans Affairs Medical Center. GEOFF FORESTERMonitor staff

Monitor staff
Published: 7/23/2017 12:32:18 AM

The public relations woman at the Manchester VA Medical Center seemed eager to help.

She smiled and extended her hand. She said she wanted to work with the press, get the truth out. She said she wanted to do what’s best for the veterans.

“We want to be transparent and let you engage,” said Kristin Pressly, the VA’s public affairs officer. “The media is our partner in informing our veterans.”

That, I thought, meant a clear path to Dr. William ‘Ed’ Kois, a whistleblower from Newburyport, Mass., who exposed substandard procedures at the Manchester VA.

Then it got weird. Pressly insisted on walking downstairs to Kois’s office. She said she had to be there during the interview, suggesting she sought to monitor the line of questioning, shape the story, smooth its rough edges.

Suddenly, there was Kois, a round, balding man with muttonchops to rival a Civil War general. He was not happy to see Pressly, nor was he thrilled to hear her plan.

“You’re not invited to sit in on this,” Kois said, angrily, forcing the interview outside.

The scene was awkward, but revealing. It illustrated the in-house battle being waged between a doctor who looks and acts like no other doctor you’ve ever seen, and a VA hospital steeped in damage control while continuing to promise information and changes.

To Kois, there’s a word for deception. Something to do with a bull and its waste. He uses the word a lot, and he says the VA reeks of it these days.

“This is the biggest issue we can have, and that is the patients not being properly taken care of,” Kois said.

His fight for better conditions at the VA has left Kois in an improbable working environment. He has his supporters on the giant campus. Janitors and van drivers and patients have stopped and thanked him.

But he’s being watched, closely. Outside, an unnamed woman approached as we talked, choosing to sit with us, 3 feet from Kois, with another empty table nearby and no one else around.

“Hi, can I sit here?” she asked.

“Who are you?” I asked.

“I’m an employee. Who are you?”

We got the hint and left, squeezing into my car on a hot day, at which time Kois said, “Can you believe that woman just came over and sat down? What the (bleep)?”

We drove and we talked. Kois told us about a veteran suffering from myelopathy who had had part of a tumor removed from his spine at a VA near Boston, then relied on the Manchester VA for subsequent checkups. His pain returned, suggesting the tumor had returned as well, yet visit after visit, year after year, complaint after complaint, the patient received hollow answers, and imaging was never done.

Then Kois, who joined the VA in 2012, looked at the man’s medical records. He instantly ordered an imaging process, the one that should have been done years ago, and sure enough, the tumor was back. But by then, the veteran’s quality of life had already changed, reducing him to a wheelchair and diapers.

“You’re seeing we had a problem and I was bringing it to the attention and I was going through the system, but they were covering it up,” Kois told me as we waited at a red light.

The news is stunning, first reported last Sunday by the Boston Globe Spotlight team. News about flies in an operating room, rusty and bloody instruments, and long waiting periods for veterans who have no time to wait.

Since then, Kois has grown madder and more suspicious, after the Veterans Affairs Office of Medical Inspector filed a report that Kois called a “sham” and a “whitewash.”

He’s using more colorful language quite freely these days. Beside the muttonchops, he has a goatee and a ponytail. His laugh sounds like a sea lion’s bark, only higher.

He doesn’t golf, nor does he belong to a country club. He’s worked at a car factory and a steel mill. He’s worked on a farm. He restored a 1956 wooden boat, 37 feet long, by hand, and locals in his neighborhood call him the hippie boat family.

“I think I’m a blue-collar doctor,” Kois said. “My roots are blue collar and I’m proud of that. So that’s where I’m at, and I think I relate to my patients because of that.”

His father was a boxer, and Kois has a well-earned reputation as a counter puncher to red tape and bureaucracy, anything that gets in the way of swept-under-the rug material.

His reputation as unfiltered and unorthodox has become widely known, as has the concern he’s shown for his patients.

Jim Wepsic, a retired neurosurgeon from Meredith, has seen this up close, saying, “If a patient has a problem, he’ll home in on it, and it wouldn’t be unusual for a patient to come to his office needing a scan, and he would call the hospital and accompany the patient there. He would go out of his way for his patients.”

That’s what’s happening now, and, in fact, it’s been going on for two years. In 2015, after seeing a pattern of myelopathy that had gone unchecked for longer than normal, Kois organized a conference to address the problem.

He spoke to doctors and even included students in the forum. He said Pressly, the PR woman who insisted on shadowing me when I got to the VA, had tried to shut him down.

“They tried to pull me off the podium, mid-conference,” Kois told me. “They said I wasn’t following the syllabus and they were worried about people losing their continuing education credits.”

Kois never quit, though, and the stress grew as he worked to get the truth out. Wepsic, in fact, blamed the heart attack Kois had two years ago on “the response he was getting from the administration, which was difficult and hard for him to put up with. He went through a lot to bring this out and correct it. The stress had some impact on him.”

It’s been a long road. Kois’s effort helped spark 10 others to come forward, including several doctors. They contacted the U.S. Office of the Special Counsel, a federal whistleblower organization, which found enough evidence to recommend an investigation by the Veterans Affairs Office of Medical Inspector, or OMI.

Kois, though, had some choice words for the OMI’s recent report, saying that a conflict of interest resulted in a check on just two of 96 patients diagnosed with myelopathy. Danger to public health was not found, but the special counsel is nevertheless going ahead with a comprehensive review.

“The majority of that 96 could have been improved by early intervention,” Kois maintains.

So now, the special counsel is asking the OMI questions, inquiring why Kois wasn’t initially interviewed when his whistle was perhaps the most ear-splitting of them all.

The counsel has other questions as well, about issues pertaining to those bloody and rusty instruments, and a doctor who copied and pasted notes from chart to chart rather than updating them. Why so little interest there, the counsel wonders?

Meanwhile, Kois continues to work on the bottom floor of the Manchester VA, an old brick building built in 1948. He knows he’s being watched, and in fact was asked to sign a gag order.

He said no, of course, and he’s not worried about job security, either.

“I’ll do something else,” Kois said. “I’m building a post-and-beam house in Littleton, so I’ll work on that. In the meantime, I’m going to work like hell here to make it happen.”

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